Helping Older People Breathe More Easily

2021 ◽  
Vol 36 (5) ◽  
pp. 224-225
Author(s):  
Chris Alderman

One important type of clinically significant lung disease that is frequently encountered by pharmacists working in consultant roles is Chronic Obstructive Pulmonary Disease (COPD). Data recently published in the Journal of the American Medical Association suggests that about 6% of people from the United States aged 40 years or older report a COPD diagnosis, and a major illness affecting more than 1 in 20 of the nation's population is unequivocally an important public health priority. Moreover, in the same report, high rates of comorbidities such as dyslipidaemia, hypertension, heart disease, and cancer are noted, along with increasing emergency department presentations and increasing expenditure on drug therapy used for COPD management.

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Gamal Agmy ◽  
Manal A. Mahmoud ◽  
Azza Bahaa El-Din Ali ◽  
Mohamed Adam

Abstract Background Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol. Results Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.


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